Endovascular technology has revolutionized the treatment of abdominal aortic aneurysms. This technology has shifted the treatment of these deadly disorders from an invasive, morbid operation to a minimally invasive option with low morbidity and mortality and length of stay. Although many patients are candidates for this less invasive repair with conventional devices, a large group of patients are not treatable because of anatomical restrictions. Some of these patients may be candidates for treatment with conventional fenestrated endografts, however there are significant limitations to the use of that technology. These limitations are often secondary to poor iliofemoral access (because of the large profile of the current devices), angulations in the aorta, the degree of angulation and disease within the renal arteries, technical limitations with regard to the creation of the holes in the current endografts or a combination thereof. Another limitation to the current available technology is the fact that a device may need to be created for each individual patient, adding delays of between three to six weeks to the treatment of the patients and patients with urgent/emergent needs would be ineligible for this treatment.